Inspiring compassionate professional nursing in the criminal justice system

Tips for Dealing with Traumatic Brain Injury

Barbara Curtis, MSN, RN, Director of Nursing Service, Washington State Department of Corrections talks about the high prevalence of traumatic brain injury in the correctional patient population and responses to the condition. Barbara has been an RN for over 30 years with 20 of those in emergency services both as administrator and clinician. She has been with correctional nursing for 11 years.

Although an estimated 2% of the general population has sustained a TBI with continuing disability, a meta analysis of studies in the inmate population indicates a prevalence of over 60% . It is suggested that this condition may be under-reported for a variety of reasons. A study performed in the Washington State Correctional System found as much as 89% prevalence. That equates to 9 out of 10 of our inmate patients having some form of brain injury.

The long-term effects of TBI are memory problems, inability to focus, and poor impulse control. Inmates with this condition may respond in anger, aggression or verbal disrespect to cover for their deficits. This means that our patients with TBI often show these behaviors:

Act out in anger or irritation

Forget rules of prohibited conduct

Not remembering where they should be or by when

Forgetting that they cannot go into certain areas

Increased behavioral infractions

TBI treatment focuses on symptom management and compensation for cognitive deficits. A careful intake history is an important first step to diagnosing TBI and managing symptoms. The CDC recommends that special attention be given to impulsive behaviors, violence potential, sexual behavior and suicide risk if the inmate is depressed.